Wednesday, July 14, 2004

Healthcare Watch: Bush's Plan Stinks ... but so does Kerry's

WASHINGTON, July 13 - New government estimates suggest that employers will reduce or eliminate prescription drug benefits for 3.8 million retirees when Medicare offers such coverage in 2006.

That represents one-third of all the retirees with employer-sponsored drug coverage, according to documents from the Department of Health and Human Services.

No aspect of the new Medicare law causes more concern among retirees than the possibility that they might lose benefits they already have.

Democrats are likely to cite the new estimates as evidence to support their contention that the new law will prompt some employers to curtail drug coverage for retirees, forcing them, in some cases, to rely on Medicare's leaner benefits. Republicans do not want to see the government supplant employers in providing drug benefits to retirees.

Senior officials at the department have been saying for weeks that they believe federal subsidies will induce more employers to continue providing drug benefits to retirees.

The bad news for Democrats is what this implies about Kerry's plan for nationalized healthcare through extending Medicaid benefits and providing indemnity for 75% of catastrophic healthcare costs beyond a certain threshold. While it is not automatically true that just because Bush's Medicare plan is a bust then Kerry's Medicaid plan will be a bust, it does show that just as the oldman predicted that you cannot extend government healthcare coverage without creating an overwhelming temptation for the private sector to reduce their coverage. So the net result is not better coverage, but simply shifting the burden from the private sector to the tax base through a corporate subsidy without really improving healthcare.

There is a way to avoid this, but it requires restructuring the entire healthcare system through negotiation, consensus, and legislation in an ongoing process. You cannot simply pass a plan through legislation to add another layer of bureaucracy and expect it to do more than shift the balance within a preset equilibrium. I understand the desire for nationalized healthcare and I appreciate the confidence that Kerry supporters have in the good will of their man, but good will is not enough.

The default for Kerry's healthcare plan is not success but failure, and to avert that will take sharp policy making and politics. It is the burden of those who seek such a plan to generate ideas for how to make it work, not to assume that if the plan is tried that it will spontaneously work itself out. To think otherwise would be to invite the juvenile and infantile thinking of the Bush Administration that believed that if they just "did the right thing" everything would work out - on Iraq, on the Economy, on Education, on Medicare, etc., etc. The devil is in the details.

If Kerry is to succeed and be a leader he's got to show that not only can he not be as much of a screw-up as Bush, but that he has real plans that will succeed where Bush clearly has no clue much less a plan.